Payment Integrity Analyst I

Role Description

The Payment Integrity Analyst ensures assigned payment integrity programs are delivered efficiently and with high quality. Using claims expertise, program knowledge, and analytics capability, this person will provide the day-to-day management of assigned programs which may include, but aren’t limited to, our CMS Demand Case program and our Subrogation program. They will research case questions, resolve issues, identify process and program improvements, and ultimately contribute to the delivery of a strong portfolio of payment integrity programs.

What YOU will do:

• Provide strong analytical, problem-solving and quality assurance skills to support efficient, accurate and timely execution of assigned payment integrity programs.
• Combine healthcare knowledge and technical skills using programs including QicLink and Excel and reporting from vendor systems to gather, assess, and perform detailed evaluations of data to:
  • Identify issues, recommend solutions, and manage situations to resolution.
  • Identify, evaluate and deliver new program improvements that increase cost containment results for HMA and its clients.
  • Track, manage, and report on daily program inventory for short-term prioritization and long-term strategic planning.
  • Evaluate existing business processes and policies and develop sustainable, measurable improvements.
  • Produce clear written documentation to ensure consistent and accurate service provision, such as Procedural Work Instructions or Job Aids for core practices and business requirements for program changes.
• Collaborate effectively with internal teams including Appeals, Claims, Client Success, and Stop Loss to deliver an informed, coordinated experience for clients and members.
• Interact and communicate effectively with payment integrity program vendors and government agencies to meet program expectations.
• Maintain current knowledge of claims processing, job-related systems, and associated government regulations, and pursue education and training relevant to Payment Analyst role.

Qualifications

• High School Diploma required.
• ICD-10 & CPT experience required.
• 3-5+ years of claims processing experience within the insurance industry.
• 2+ years data entry experience.
• Intermediate Excel skills with the ability to build effective spreadsheets and manipulate data.
• Able to manage a complex daily queue and prioritize workload effectively.
• Skilled in identifying root causes of issues through detailed investigation and inquiry.
• Able to analyze impacts of potential actions or decisions to determine the optimal choice.

Compensation

The base salary range for this position in the greater Seattle area is $73,000-$81,000 and varies dependent on geography, skills, experience, education, and other job or market-related factors. Performance-based incentive bonus(es) is available.

Benefits

• Seventeen (IC) days paid time off (individual contributors).
• Twelve paid holidays.
• Two paid personal and one paid volunteer day.
• Company-subsidized medical, dental, vision, and prescription insurance.
• Company-paid disability, life, and AD&D insurances.
• Voluntary insurances.
• HSA and FSA pre-tax programs.
• 401(k)-retirement plan with company match.
• Annual $500 wellness incentive and a $600 wellness reimbursement.
• Remote work and continuing education reimbursements.
• Discount program.
• Parental leave.
• Up to $1,000 annual charitable giving match.

How we Support your Work, Life, and Wellness Goals

At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in-person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party.

Company Description

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service.

We are proud to say that for three years, HMA has been chosen as a ‘Washington’s Best Workplaces’ by our Staff and PSBJ™. Our vision, ‘Proving What’s Possible in Healthcare™,’ and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results.